Evaluation of aggrecan and adipokine levels in temporomandibular joint synovial fluid.

The aim of this study was to investigate the effect various mediators in synovial fluid (SF) on the pathogenesis of temporomandibular disorders (TMD) and to evaluate the relationship between clinical and radiological features of temporomandibular joint (TMJ) diseases. Patients who had received SF sample during arthrocentesis because of TMD were included in this study. Clinical and radiological records were evaluated retrospectively. Enzyme-Linked ImmunoSorbent Assay (ELISA) method was used for analysis of aggrecan, adiponectin, resistin, apelin, Vascular Endothelial Growth Factor (VEGF) and Prostaglandin E2 (PGE2) in SFs. 59 joints of 41 patients were included in the study. Anterior disc displacement with reduction (ADDwR) was detected in 22 joints, anterior disc displacement without reduction (ADDwoR) was detected in 29 joints and osteoarthritis (OA) in 8. In OA group, PGE2 level was significantly higher than the other groups (p = 0.029). Aggrecan and PGE2 levels were statistically higher in joints with localized pain (p = 0.030, p = 0.029). The aggrecan level was statistically significant higher in patients who had degenerative changes in radiological examinations (p = 0.044). Resistin was correlated with PGE2 and aggrecan (p = 0.011), and apelin showed positive correlation with VEGF (p˂0.001). The detection of aggrecan and adipokines in SF may be a precursor of degenerative joint disease and it should be taken into account that the presence of localized pain in the joint area may be an early sign of degenerative changes.

Development of a new three-directional distractor system for the correction of maxillary transverse and sagittal deficiency.

PURPOSE: Class 3 malocclusions with maxillary deficiency, which are treated surgically and/or ordonotically, are common among adult patients. The aim of this study was to develop a three-directional bone-borne distractor that would allow the transverse expansion and sagittal advancement of the maxilla simultaneously. MATERIALS AND METHODS: Computed tomography images of a patient with maxillary deficiency were transmitted to a software program, and a distractor was designed with different sizes (D1, D2, D3) and manufactured from titanium alloy. Y-shape segmental osteotomies were performed on the model, and vertical bite forces were applied. The biomechanical properties were evaluated by using the finite element method. RESULTS: The highest von Mises stress value on the body of the distractor was seen in D2 (D2>D3>D1), with 234 N bite forces. D2 had maximum stress distribution on maxillary bone under 234 N and 93 N (D2>D1>D3). No difference was found among the plastic deformation rates according to biomechanical test results. CONCLUSION: A three-directional bone-borne palatal distractor was produced, and this distractor system can be used for the treatment of skeletal class 3 patients with maxillary hypoplasia for its advantages of shortening the overall treatment time and reducing the scar formation. However, further animal and clinical studies are essential to determine the biological response of soft and hard tissues.

Treatment of bisphosphonate-related osteonecrosis of the jaw using platelet-rich fibrin.

BACKGROUND: Bisphosphonates are commonly prescribed antiresorptive agents for the management of patients with osteoporosis, Paget's disease, multiple myeloma, and metastatic tumors. Platelet-rich fibrin (PRF) is a second generation platelet concentrate, and has the ability of regulating the inflammation and stimulation of chemotactic agents. The aim of this report is to present the treatment of Stage-3 bisphosphonate-related osteonecrosis of the jaw (BRONJ) by PRF. CLINICAL PRESENTATION: A 77-year-old male patient with Stage-3 BRONJ was treated with minimal surgical operations and PRF membrane. The patient was followed up for 18 months, and there was no recurrence or exposure. CONCLUSION: PRF may promote the healing of both bone and soft tissues even in Stage-3 patients. This technique is an alternative treatment modality for the closure of bone exposure and tissue healing in BRONJ patients.

Oral leukoplakia associated with amalgam restorations.

The World Health Organization has defined oral leukoplakia (OL) as "a white patch or plaque of the oral mucosa that cannot be characterized clinically or pathologically as any other disease". A 21-year-old male with OL presented with a bilateral burning sensation in the buccal mucosa. The patient had amalgam restorations, and an epicutaneous patch test indicated a positive response to amalgam. The amalgam restorations were therefore removed and the cavities were refilled with a composite resin restorative material. During 5 years of follow-up, there was no recurrence of the oral lesions. This case illustrates that amalgam fillings may cause OL lesions. (J Oral Sci 58, 445-448, 2016).